Little data exists that addresses success in lifestyle change for African-Americans living with diabetes and co- morbid hypertension, who represent a high risk group with multiple adherence challenges related to lifestyle and medical management. African-Americans are more likely to develop complications related these co-morbid conditions, such as retinopathy, nephropathy, and lower-extremity amputations. This increased burden of disease is partly due to poor management of patient initiated risk factors which include lack of exercise, being overweight or obese, and poor dietary practices. Effective management of comorbid Diabetes and Hyper- tension involves initiating and sustaining complex behavioral changes to accommodate the large number of lifestyle modification recommendations that both conditions require. African-Americans are less likely to engage in self-management behaviors known to improve outcomes related to hypertension and diabetes and are in need of interventions that improve self-management. Peer-led interventions have shown moderate success at influencing self-efficacy, caloric intake, and physical activity and hold promise for future development. The primary aims of the proposal are 1) to design a group-based, culturally appropriate self- management skills training intervention for disadvantaged African-Americans with both diabetes and hypertension and to compile an intervention Manual of Operations (MOO);2) to recruit and train peer leaders to deliver the self-management skills training intervention; 3) to determine, in this population, whether the addition of a culturally sensitive, peer-led self-management skills training intervention, added to standard diabetes education, can achieve an improvement in self-efficacy at adherence that is 1 standard deviation greater than that achieved by standard diabetes education alone at one year; to determine, in this disadvantaged population, whether the addition of a culturally sensitive, peer-led self-management skills training intervention, added to standard diabetes education, can achieve a 35% greater improvement in adherence to relevant risk factor recommendations than that achieved by standard diabetes education alone at one year. The relevant risk factor goals are physical activity, dietary goals of <2400 mg. of salt/day and 45-65% intake of carbohydrates/ day; weight reduction goal of >5% of baseline weight. The pilot study will also help to determine the key elements needed to calculate sample size for a larger trial. The results of this pilot work will be used to plan a large-scale behavioral clinical trial to initiate, maintain, and sustain necessary self-management behaviors in this important, underserved population. Public health impact: Findings from this study and future studies of the same can help identify cost-effective, culturally effective ways to help African-Americans who have both diabetes and hypertension to approach and make lifestyle changes that will make them healthier. Little data exists that addresses success in lifestyle change for African-Americans living with diabetes and co-morbid hypertension, who represent a high risk group with multiple adherence challenges related to lifestyle and medical management. This increased burden of disease is partly due to poor management of patient initiated risk factors which include lack of exercise, being overweight or obese, and poor dietary practices. Effective management of co-morbid Diabetes and Hypertension involves initiating and sustaining complex behavioral changes to accommodate the large number of lifestyle modification recommendations that both conditions require. African-Americans are less likely to engage in self-management behaviors known to improve outcomes related to hypertension and diabetes and are in need of interventions that improve self- management. Peer-led interventions have shown moderate success at influencing self-efficacy, caloric intake, and physical activity and hold promise for future development. The step proposed to be taken in this grant application will draw on the support that does exist for the use of peer educators and, in hopes of strengthening treatment effects, will draw on the proven strategy of frequent, intensive contacts and highly organized training to promote a beneficial treatment outcome in this difficult to reach sample of underserved minority patients living with co-morbid diabetes and hypertension. [unreadable] [unreadable]